Novel Approach for Management of Extremely Rare Pleomorphic Adenoma of Soft Palate (Minor Salivary Glands).

Salivary gland tumours account for 2-3% of tumours occurring in head and neck region, majority of them being benign. Pleomorphic Adenoma present mainly in Parotid gland and Sub-mandibular gland and rarely in minor salivary glands. The tumours of minor salivary glands are generally malignant. The commonest sites of intra oral Pleomorphic adenoma are palate, lip and buccal mucosa. Here I describe a very rare case of Pleomorphic Adenoma in minor salivary glands and its novel management using CO2 Laser. There was no recurrence seen after a follow-up period of around one year.

A Comparative Prospective Study to Evaluate Outcomes of Ossiculoplasty using Autograft Versus Synthetic Graft.

Chronic Otitis Media is the most common cause of hearing impairment with ear discharge with which patients report to any otologist. The aim of management in such cases is to provide a safe ear and restore the hearing by Tympanoplasty. Many materials have been used for ossicular reconstruction, including both biological and synthetic materials. Minimally destroyed ossicle can be utilized for Ossiculoplasty while in case of complete destruction of ossicles, synthetic materials may be used such as teflon, titanium, hydroxyapatite etc. To evaluate the outcome of Ossiculoplasty using autograft versus synthetic graft. A prospective study done using non-probability convenience method of sampling involving a group of 50 patients were subjected to Tympanoplasty with Ossiculoplasty. Intra operative decision was taken on the type of graft to be used for Ossiculoplasty and the patients were divided into two equal groups, A (autograft) and B (synthetic graft) of 25 each. The patients were thereafter evaluated post surgery at periodic intervals of 3, 6 and 12 months. The improvement in hearing following surgery was significant (AB gap < 20 dB) in the range of 72% in Group A to 84% in Group B of patients 12 months after surgery. Also there was a 37% change in AC in Group A as compared to 40% in Group B, demonstrating marginally better improvement in hearing with synthetic graft as compared to autograft. The patients have significant improvement in hearing thresholds after ossiculoplasty with both autograft and synthetic graft. Teflon is an excellent alternative for ossiculoplasty when autologous incus is not available for use due to disease.

A Prospective Study to Elucidate the Efficacy of 4 Oral Prednisolone Regimens in Acute Acoustic Trauma.

Noise induced hearing loss affects around 5% of the population and acoustic trauma to military personnel accounts for 30% of all injuries inflicted during active service. Initial treatment for acoustic trauma involves administration of steroids, however there are no studies regarding oral steroid regimens for best outcomes. Comparing and elucidating the benefits of four oral steroid regimens on hearing gain in patients with acute acoustic trauma. A prospective study of 4 different steroid regimens was done in 200 soldiers from July 2014 - July 2020. In the first group, oral Prednisolone 60 mg was administered for 6 days, in the second group for 8 days, in the third group for 10 days and in the fourth group for 12 days. Medication was tapered over the next 5 days in all the groups. Data analysed included demographics, Pure Tone Audiograms at admission and at 4 weeks, time of reporting to hospital, onset of treatment and type of treatment given. Multivariate linear regression model was done to consider the risk factors responsible for average hearing gain at all pure tones. Box-and-whisker plot, Mann-Whitney-Wilcoxon test, Kruskal Wallis test, Reciever Operating Characteristic curve were used to analyse the independent samples. p value of < 0.05 was considered statistically significant. Age, time of onset of prednisolone therapy and acoustic trauma due to blast or gunshot injury did not show correlation (R2 = 0.01, 0.01 and 0.35 respectively and p = 0.09, 0.71, 0.80 respectively). Prednisolone therapy, average initial hearing at pure tones were considered as factors responsible for hearing gain as they showed correlation (R2 = 0.22, and 0.34 respectively and p < 0.001 and < 0.01 respectively). Significant hearing gain was found in all groups. The hearing gain was statistically better in group 3 and 4 as compared to group 1 and 2. There was no statistically significant difference in hearing gain between groups 3 and 4. So there was no additional advantage of giving 60 mg oral prednisolone for more than 10 days. The best oral prednisolone regimen recommended is 60 mg/day for 10 days which is tapered over the next 5 days.